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Windlass mechanisms - plural - and diabetes

These are extracts from a thread I have posted on Podiatry Arena . Any comments welcome .

Post 1

So during the gait cycle the windlass mechanism is engaged and reversed twice . Going from heel strike to heel strike we have windlass , reverse windlass , windlass and then reverse windlass at toe off . Yes ?

Post 2

So in this short clip we have windlass ,reverse windlass ,windlass ,reverse windlass ?

So with regard to the above , the toe extensors contribute to arch stiffness during early stance by dorsiflexing the hallux and lesser toes and tensioning the plantar fascia . As stance progresses and ground reaction forces build , it seems likely that the prestrike , dorsiflexed position of the hallux/lesser toes will allow the plantar fascia and plantar intrinsics to load over a greater period of time reducing the stresses to which these tissues are subjected and so reducing the chances of plantar fasciitis developing .Question .Can the first of the two windlass cycles during gait be significantly inhibited by footwear ?

Post 4

So the extensors contribute to foot stiffness .

In the case of a foot with intrinsic foot muscle atrophy caused by diabetic neuropathy , the foot likely becomes a less effective lever during gait , especially during late stance . Thus the musculo/neural/skeletal system may , through the information received by proprioception inputs , slowly adapt to the changing capabilities of the foot by causing gait to be altered in such a way as to reduce the work load of the forefoot during toe off . Hence a high stepping gait or a shuffling gait may develop .

However , I believe it is plausible that intrinsic muscle atrophy may also , in part , be compensated for by increased activity of the external toe EXTENSORS . Increased use of the toe EXTENSORS would tension the plantar fascia during midstance and late stance giving a more rigid lever and more proximal plantar pressures during these phases of stance .

Using the extensors in this way may lead to permanent extension of the proximal phalanges of the hallux and lesser toes , giving rise to cocked /claw toes . The fat pad under the met heads would migrate distally giving rise to pressure problems and ,over time the entire forefoot may start to curve upwards .

A cavus foot would also likely develop as the plantar fascia is tensioned by the extrinsic toe EXTENSORS to compensate for reduced plantar intrinsic input .

Could all of this be greatly helped by a podiatrist led ,conservative approach to the intrinsic foot muscles using an appropriately prescribed and supervised progressive resistance exercise program ?

Back to Dr Karen Mickle and her trial . "Evaluating a foot strengthening exercise program to improve foot function and foot health in older adults with diabetes"